On a related note, available jobs via Hospital Recruiting are now displayed on my Jobs page, with results based on your current location. Check it out, then read on for Dr. Schwindt’s gripping story.
A massive smile creased my lips upward as the rumble of the moving truck pushed the miles farther behind. My dream job and life on a quiet lake lay in wait at the end of this day’s journey. Trading in urban life and working two to three weekends every month required little neuronal firing.
The first few years went as slated. Decent hours, great pay, no call, and a package of benefits topped off a generous pension and profit sharing package. I felt that I had arrived at my final professional position, and all indications promised a fulfilling career with a long-standing democratic group.
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A Buyout Changes Everything
The wake-up call came just a few years later. The stated merger with a larger national group was nothing of the sort. I soon found my pay restructured, pension wiped out, and profit sharing canceled. By then, my family was firmly rooted in the community and moving was not an option. As I watched many of my colleagues and friends pack up and leave, I found myself drowning in this bleak new reality.
Departing physicians were replaced with new graduates of physician assistant and nurse practitioner programs. I was tasked with supervising five mid-levels, as well as seeing a full load of my own patients. Fortunately, a few of the PAs were exceptional and kept me on my toes with insightful questions and teaching opportunities. The others required constant oversight and tripled my workload. Days now ended with a pile of dictations, and 11 P.M. became the new norm.
My family was patient, but my attitude suffered, and fatigue ruled the day. Living in a small town left scant professional options. The corporate practice of medicine had gobbled up every practice, clinic, and hospital within a few hours drive.
Searching for a Viable Plan B
Relying on resourcefulness and the help of a recruiter turned friend, I found several high paying emergency departments crying out for help. The shortage of board certified EM physicians played to my favor. I scaled back at my “day job” and began researching how to rebrand myself.
Those times were trying, but I was fortunate to connect with several other physicians who suffered through corporate takeovers and retooled their professional skill set to regain freedom. I began an honest inventory of my interests and a diligent search for options.
With guidance from a physician mentor, I was introduced to functional medicine.
I continued to endure the day-to-day and groaned under the growing administrative burden imposed by the corporate bosses. After a brutal stretch of working short staffed and packing in ER shifts, I had reached the melting point.
I walked into my office after arguing with a patient about not giving her Vicodin for a bladder infection and noted a pile of chart reviews due for the mid-levels that had been placed on my chair and marked “Due by 5 p.m. today!” Nothing surprised me anymore, and I felt numb. The daily grind consisted of little more than pushing as many patients as possible through the door. The joy of practicing medicine had been sucked out of me.
Glancing up, I noticed the group’s chief medical officer smirking as he glided into my office. He was the wise one and had traded his stethoscope years ago for predictable hours and the final say.
Charting a New Course
“I can’t do this anymore.” It just came out. No filter. Plainly stated.
He nodded, smiled, and asked what my plan was. I replied that I had no idea but that it would not include working like this anymore. We agreed on finishing out the month and parted on friendly terms.
Free to chart a new course, I capitalized on the functional medicine knowledge and began working with individuals highly motivated to optimize all aspects of their health. Novel therapies, innovative testing protocols, and imaging provided clear direction on how to reach beyond just being normal on some lab result slip.
Applying cutting edge information and self-experimentation delivered interesting and surprising results. Had my dream job not been destroyed due to a corporate takeover, I’d be dead. Actually dead.
Self-directed testing and imaging have become commonplace. Given a troublesome family history, I ordered a coronary calcium CT scan. The preliminary results were perfect with a score of zero.
Fast forward a few weeks, I noticed a letter from the imaging center. I was tempted to file it away for later as I already knew the results, but something told me to take a look now.
I felt the color drain from my face and a nauseous feeling brewing in my gut as I read the final summary. Calcium score zero, however, a large thoracic aneurysm is noted. Prompt follow up required.
Had my career not been steered in a new direction, I would have plowed ahead with training, racing, and competition. I had signed up for several challenging obstacle races shortly before receiving that fateful letter from a cardiologist. Like nearly every patient with an aneurysm, I had no symptoms and no warning that imminent danger lies ahead. Many of life’s experiences bring short-term pain and despair, but the power and beauty of the lesson reveals itself in due time.
[post-publication edit: While this anecdote resulted in a tremendous benefit for the physician, incidental findings can also lead to disatrous consequences. In general, I do not believe in screening tests without a good indication.
I’ve heard a different anecdote of an incidental spot seen on a patient’s liver, which led to an invasive procedure, which led to infection, sepsis, and ultimately the demise of an otherwise healthy patient whose “spot on the liver” turned out to be nothing.
I liked this story for the role of serendipity and the juxtaposition of a corporate takeover leading to positive changes in this physician’s life]
Has the corporitization of medicine affected your job? Have you made any changes as a result? Please let us know your thoughts below.
VERY long time reader. Inspired to comment for the first time. Started off very excited, nodded my head at the increasing corporatization and subsuquent frustrations. But then I read on and was sorely dissapointed. People look to us as MDs to eschew this sort of anecdotal medicine which at best is on the cutting edge (and will eventually be validated) and at worst is dangerous or deadly. Giving a platform to this individual does a disservice to all physicians and cheapens your site. His scare story, while moving on a personal level, is frankly irresponsible. CT scans on young healthy people on the off chance we might catch something? No thanks. Your previous comment on the danger of the “incidentaloma” is right on the money. Why should insurance pay for something like this that doesn’t have scientific backing. If we want to “take back” medicine we need to be reasonable because most of us ARE reasonable. We don’t want to order batteries of expensive tests that are not indicated on a population level. We just want to practice medicine in an evidence based manner without insurmountable beaurocratic hurdles. In your effort to get content you have lost my respect.
Thank you for your honest comment, Dr. G.
I agree that indiscriminate screening will lead to more problems than good, despite the stories like Dr. Schwindt’s or David Letterman’s where substantial, asymptomatic threats were discovered. With this story, I was moved by the serendipitous nature of the diagnosis and the contrarian concept of corporate med chaning a doc’s life for the better, which seems to be quite rare.
I didn’t mean for it to be an endorsement of random radiologic testing, and perhaps my qualifying statement belongs in the text of the article rather than in the comments. I will make that change, and I hope I haven’t lost you as a reader.
Best,
-PoF
Thanks for your reply. You have not lost me- I’m way too reasoned to let one post get in the way of my enjoyment of a wonderful site. The whole “functional medicine” aspect also just rubbed me the wrong way. I want to use FI to make my life easier but I’m hoping that financial considerations don’t make people back out of medicine and start peddling snakeoil. Now I know that not all of functional medicine is snake oil but sadly some of it is. We have enough NPs and naturopaths trying to convince people they don’t need boring old evidence based medicine – try just eating vitamins! I work in LA where so many physicians have jumped the shark and it’s sad. It’s sad because I get why. Corporatization of medicine is the worst. But I hope we band together instead of just selling hope and fear.
Very moving recount. Glad something shifted for the author! I need to read more about functional medicine. Not very familiar with its ins and outs. Thanks for sharing.
As a radiologist, I can see the allure of taking a look just for good measure. I’m really glad for the author that he found something he could act on. But I can also assure you that false positives abound and that getting a test without an indication significantly reduces the positive predictive value of a given result. So I’m pretty cautious about the idea of self-directed testing. It has a lot of potential for harm as well.
Oi – well thank goodness! Glad to hear you were able to catch something so catastrophic, after a less than awesome instigator.
My GP had a slightly related story, super athletic person, they got an ultrasound machine for the clinic he worked in, so he was playing around with it, on himself. Discovered a *massive* heart problem, for which he had surgery that week and over a year of treatment and recovery. Total fluke. Saved his life.
What a great story. Some good fortune with the diagnostic finding, but really you made your own luck in many ways. You got painted into a corner with corporatization, but instead of playing a losing game further you had the insight, initiative, and courage to change the rules, “re-focus”, and blaze a new road. I am Canadian physician and while the source of the productivity and financial pressure is a bit different here, the effects on morale are the same. I have really begun to notice it in my collegues (and self) over the past couple years. I can only hope we have similar courage and initiative to find new roads rather than burn-out.
Wow – amazing story and glad you dodged a bullet. I am amazed at how arbitrary medicine can be at times – for a non-doctor, would our GP ever, based on family history, order a coronary calcium CT scan? (And perhaps even more relevant in the insane complexity of U.S. healthcare, would it be paid by insurance?) Thanks for a great cautionary tale which raises some important questions!
In this case, the incidental finding in a screening test was quite fortunate.
On the other hand, you can have disastrous consequences. I’ve heard an anecdote of an incidental spot seen on a liver, which led to an invasive procedure, which led to infection, sepsis, and ultimately the demise of an otherwise healthy patient whose “spot on the liver” turned out to be nothing.
Best,
-PoF
Thank you for saying this! The author is clearly very lucky to have found something that could be treated, but I deal with patients all the time who go through a huge amount of anxiety and unnecessary testing/interventions as a result of things that are discovered incidentally. Testing is not benign!
So incredibly true. Testing is most certainly not as benign as it seems to the lay public. Despite our ability to test/screen/diagnose more and more pathology, much of it has not reduced mortality/morbidity and has even resulted in increased mortality/morbidity.
As an EP, it’s something that I find incredibly difficult to explain to the educated public, let alone the less savvy.
Good example of why we should live life to its fullest each day. You never know what tomorrow might bring. Glad you found it before it found you.
Such a moving story. Glad you found out early about the aneurysm.
I’m not a doctor but it sounds like my ex-dermatologist was going through corporatization too? As soon you walk in, before even getting a chance of sitting down, he would say :”The last prescription didn’t work? He’s a new one. Thanks for coming in, see you next time”. He would see like 60 people in an hour!
Thanks for the guest post, Mitchel. Is your new job a remote one, or is it in your community? I’ve heard several people sing the benefits of imaging and testing to identify health problems normal labs could miss. Is a lot of what you do related to diet, supplements, and the like? Or do you use lab results and imaging to make diagnoses for patients? Your own story is such a near miss. I can’t imagine what you were feeling.